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Twenty-Four-Hour Central Ambulatory Blood Pressure: Relationship With Measures of Cardiovascular Subclinical Organ
Ing Ni Lu1,2, Shikai Yu2,3, Gisele J Bentley2
1Clinical Pharmacology and Therapeutics Cambridge University Hospitals NHSFT Cambridge UK.
Insights
Ambulatory central systolic blood pressure (cSBP) is a better predictor of cardiovascular organ damage than brachial SBP. Calibration methods significantly impact cSBP
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Diagnostic Imaging
Background:
- Ambulatory central systolic blood pressure (cSBP) shows stronger association with left ventricular mass index than brachial SBP in some studies.
- The relationship between ambulatory blood pressure and other subclinical organ damage markers is not well understood.
- Investigating cSBP and brachial SBP in relation to organ damage and calibration methods is crucial.
Purpose of the Study:
- To assess the association between ambulatory brachial SBP and cSBP with subclinical organ damage.
- To evaluate the influence of waveform calibration methods on these associations.
- To analyze data from a large community-based cohort of untreated individuals.
Main Methods:
- Simultaneous 24-hour ambulatory brachial and central blood pressure measurements in 1311 participants.
- Assessment of left ventricular mass index (n=675), carotid intima-media thickness (n=610), and aortic pulse-wave velocity (n=1091).
- Statistical analysis to determine associations and the impact of calibration methods.
Main Results:
- Left ventricular mass index was most strongly associated with cSBP calibrated by mean and diastolic blood pressure (β=0.237, P<0.001).
- Carotid intima-media thickness showed a significant association with cSBP (β=0.141, P<0.001), but differences between blood pressure indices were not significant.
- Aortic pulse-wave velocity association was similar for both brachial and central SBP, unaffected by calibration method.
Conclusions:
- Ambulatory cSBP offers valuable cardiovascular risk information.
- The method used for waveform calibration significantly influences the association between cSBP and organ damage.
- Further research into optimal calibration methods for cSBP is warranted.
Background:
In most, but not all, observational studies, ambulatory central systolic blood pressure (cSBP) is more closely related to left ventricular mass index than ambulatory brachial SBP. However, the association with other markers of subclinical organ damage is poorly understood. We investigated the association between ambulatory brachial SBP or cSBP and measures of subclinical organ damage, together with the influence of waveform calibration method, in a large community-based population of untreated individuals.
Methods:
In all, 1311 participants (mean age, 45±18 years; 589 women) had simultaneous measurements of ambulatory brachial and central pressure over 24 hours. Of these, left ventricular mass index was assessed in 675 individuals, carotid intima-media thickness in 610 individuals and carotid-femoral (aortic) pulse-wave velocity in 1091 individuals.
Results:
Left ventricular mass index was most strongly associated with cSBP, calibrated using mean and diastolic blood pressure, with a β coefficient of 0.237 (95% CI, 0.225-0.453; P<0.001). The adjusted (partial) correlation coefficient for this association was also significantly higher versus both brachial SBP and cSBP derived from calibration using SBP and diastolic blood pressure (P<0.001 for both). The same was true for carotid intima-media thickness (β coefficient=0.141 [95% CI, 0.777-2.502]; P<0.001), although the adjusted correlation coefficients did not differ significantly between ambulatory blood pressure indices. In contrast, aortic pulse-wave velocity shared a similar association with both brachial and central ambulatory pressure, with no obvious effect of waveform calibration method.
Conclusions:
Ambulatory cSBP may provide valuable additional information concerning cardiovascular risk, although the method of waveform calibration exerts a marked impact.
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